COMBINED PLASTIC OF POSTOPERATIVE MEDIAN ABDOMINAL HERNIA OF LARGE AND GIANT SIZES

M.M.MAMAKEEV, J.S.ABDULLAYEV, N.K.BAETOV, B.MAYKANAEV, K.TURDUMAMBETOV

National Surgical Center, State Medical Academy of Kyrgyzstan, Bishkek, KYRGYZSTAN

Introduction. Postoperative median ventral hernia (PMVH) are the most common complications of abdominal surgery. Treatment and rehabilitation of such patients is a quite complex and urgent problem of surgery.

Materials and methods: We present the results of treatment of 88 patients with PMVH oflarge and giant sizes - W3 - W4 according to the Chevrel - Rath (2000)classification. The age structure of patients: under 50 years - 34 (39%), above 50 years - 54 (61%) persons, of them - 62 are women (70%), and 26 (30%) are men. After the excision of the skin with subcutaneous tissue with the postsurgical scar, a hernial sac is defined, opened excised with the cicatricial edges of aponeurosis. In case ofadhesion in the abdominal cavity, and partial obstructions of the intestine, they were eliminated. Further abdominal wall skin with subcutaneous fat was laterally separated on both sides and aponeurosisof the external oblique abdominal muscles was cutaccording to Ramirez. This allows to greatly reduce the width of the hernial defect, suture the inner edges of ofrectus muscles without tension and eliminatediastasis up to 20 cm. A polypropylene “on lay” top net was placed on top and fixed to aponeurosisof the anterior abdominal wall by a polypropylene thread. Edges of the net shall go beyond the edges of sutured hernialorificeby 5-6 cm. Free edges of the skin with subcutaneous tissue from both sides was excised, so they could sutured without tension. Subcutaneous tissue was drained by 1 - 2 drains with their attachment to such vacuum system as Redon. Drains were removed on 4-5th day with the volume of discharge less than 5-10 ml per day.

Results.In 6 (6.8%) patients there was found seroma formation, which was eliminated by punctures under ultrasound guidance. In 3 (3.4%) patients there was found suppuration of subcutaneous tissue with separation of the aponeurosis edges. Long-term results of treatment (within 6-12 months) were traced in 50 patients. No signs of recurrence were observed.

Conclusions. As a result of the combined method of treatment it becomes possible to perform surgical correction of PMVH of any sizes, whichhelps to achieve social and labor rehabilitation of the patient in shorter period and to reduce duration of treatment

Date: 2014-12-28; view: 949